Chronic Obstructive Pulmonary Disease Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease Youssef Yammine, MD,1 Mazen Kreidy, MD, Msc2 and Tarek Dernaika, MD3


1. Second-year Fellow; 2. Fellow, Pulmonary and Critical Care Medicine; 3. Assistant Professor of Medicine, University of Oklahoma Health Sciences Center, Pulmonary and Critical Care Medicine


Abstract


Chronic obstructive pulmonary disease (COPD) is one of the most disabling conditions in middle-aged and elderly Americans. It is considered a global health issue, with cigarette smoking being the most important universally known risk factor. However, COPD is more than just a lung


disorder as it affects other end-organs, making it a multisystem disease. Although forced expiratory volume in one second (FEV1) remains the most important physiologic indicator of the severity of airflow obstruction in COPD, myriad systemic manifestations that accompany this disease can effectively signal an increased risk for mortality. The best treatment remains smoking cessation. Medical therapy consists of short-acting bronchodilators early during disease progression and long-acting bronchodilators, with or without inhaled corticosteroids, at an advanced disease stage. Pulmonary rehabilitation is of great benefit in improving dyspnea and quality of life, whereas long-term oxygen therapy and lung volume reduction surgery are unique in their ability to prolong survival in selected patients with COPD.


Keywords


Smoking, forced expiratory volume in one second (FEV1), bronchodilator, body mass index and percentage of predicted FEV1, dyspnea, and the six-minute walk distance (BODE) index


Disclosure: The authors have no conflicts of interest to declare. Received: September 19, 2010 Accepted: December 15, 2010 Citation: US Respiratory Disease, 2010;6:8–13 Correspondence: Tarek Dernaika, MD, University of Oklahoma Health Sciences Center, Pulmonary and Critical Care Medicine, 920 Stanton L Young Boulevard, WP 1310, Oklahoma City, OK 73104. E: Tarek-Dernaika@ouhsc.edu


Chronic obstructive pulmonary disease (COPD) is a major global health problem, and one of the few diseases in which the mortality rate continues to rise. The increase in mortality attributed to COPD might represent a reflection of an aging population as well as the relative effectiveness of therapies available for other common conditions, such as cardiovascular disease and many cancers. Consequently, COPD is projected to be the third leading cause of death in the world by 20201 and women have exceeded men in the number of deaths attributable to COPD for the seventh consecutive year.2


(≥18 years of age) were estimated to have COPD;3


In 2007, 12.1 million US adults however, close to 24


million US adults show evidence of impaired lung function, indicating an underdiagnosis of COPD.4


COPD is associated not only with significant


levels of morbidity and mortality in the US, but also with a substantial economic burden and increase in direct and indirect healthcare expenditure, with a projected cost in 2010 of US$49.9 billion.5


Definition


COPD is defined as a chronic disease characterized by airway, alveolar and systemic inflammation, with measured airflow obstruction that is partially reversible with bronchodilator therapy.6


COPD reflects a new level of optimism; it is no longer considered an irreversible obstructive lung disease, but rather a disease in which airflow obstruction and other key characteristics can be


8 This definition of


partially reversed with the appropriate use of pharmacologic and non-pharmacologic therapies.7


Although the terms ‘chronic bronchitis’


and ‘emphysema’ often co-exist in COPD, they are no longer included in the formal definition of the disease. Emphysema is a pathologic term used to describe destruction of the alveolar–capillary membrane, whereas chronic bronchitis is a clinical term used to describe the presence of cough or sputum production for at least a three-month duration during two consecutive years.7


Risk Factors


There is no doubt that smoking is the most important risk factor in the development of COPD.8


Classic studies have confirmed that smoking


The Lung Health Study quantified the benefit of smoking cessation, showing that persistent smokers continue to lose 70–100ml per year of lung function, as measured by forced expiratory volume in


accelerates the natural rate of lung function decline expected with the aging process and that smoking cessation slows the acceleration of this decline.9


one second (FEV1), whereas the rate of loss in ex-smokers is closer to the 30ml per year seen in non-smokers.10


A small percentage of


smokers do not appear to develop clinically significant COPD, suggesting that genetic factors modify the risk of developing disease in a few fortunate individuals. Conversely, <1% of COPD patients have α1-antitrypsin (AAT) deficiency, a known genetic defect that


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